More Than a Mandate

Yesterday, the odds on intrade were 76% that the Supreme Court will declare the health care insurance mandate unconstitutional.

This started me thinking about Social Security during 1935. Several states had old age insurance and the federal government was feeling the pressure. Advocates of a federal system agreed that means testing had to be avoided because it demeaned those who did not make the cut. The solution was shared employee/employer funding through a payroll tax. Having earned the benefits, rich and poor would feel no stigma when the check arrived in the mail. Perceived as a universal entitlement, Social Security would not be a poverty program.

We could say that Social Security has been successful because it became a “social norm.”

NY Times financial writer Eduardo Porter suggests that the mandate to purchase and receive health insurance in the Affordable Care Act also needs to become a social norm. If it does not, then healthy individuals will figure out ways to sidestep the system. And if they do, funding will be insufficient to support those who need medical assistance. So he says, it does not matter what the Supreme Court decides. The insurance buying mandate will only work when it becomes our social norm. And right now, a CBS News/NY Times poll indicates that close to 70 percent of us oppose it.

Our bottom line: Like Social Security, should a health care insurance mandate become a social norm?

Here, you can check current intrade odds on the Supreme Court individual health care mandate decision. For Social Security history, The Real Deal (1999) by S.J. Schieber and J.B. Shoven and The Predictable Surprise (2012) by S.J. Schieber provide excellent facts, insights, and program alternatives that give Porter’s column relevant background.